Kadine Priscila Bender dos Santos

Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

Summary Background Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses. Methods We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries. Findings Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index. Interpretation Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities. Funding Bill & Melinda Gates Foundation and the Brazilian Ministry of Health.

Intervenções fisioterapêuticas utilizadas em pessoas amputadas de membros inferiores pré e pós-protetização: uma revisão sistemática

Physical therapy interventions in amputee patient before and after the placement of a prosthesis are cited in a variety of physical therapy services, however, it is necessary to systematize evidence of rehabilitation protocols. Objective: The objective of this study was to add scientific evidence to guide the physical therapy practice in preand post-fitting of lower limb amputee. Method: We conducted a systematic review during the months of August to December 2014 in the databases Lilacs, Medline, Pedro, Pubmed, Scielo and Cochrane. Articles published from 2000 to the first half of 2014 were selected by key words in Portuguese, English and Spanish. Results: Six articles met the inclusion criteria, and only one was related to the pre-fitting stage highlighting the intervention: bandaging of the stump. The other interventions referred to the post-fitting stage as muscle force training, aerobic training, functional and gait. Conclusion: Few articles were found with scientific evidence related to major interventions pre and post prosthesis routinely used by the physiotherapist, which hinders the establishment of protocols and the reinforcement of the effectiveness of commonly described therapies.

Isokinetic assessment of lower limb in an athlete with below-knee amputation: a case study

AIMS: To evaluate the effects of isokinetic training on peak torque and maximum power of the flexor and extensor muscles of the knee and hip articulations in an athlete with lower limb amputation CASE DESCRIPTION: We assessed a 27-year-old triathlete amputee, with congenital amputation of proximal third of right tibia and user of high-performance prosthetics for running. The circumference of both lower limbs were measured, and an isokinetic dynamometer was used to estimate the peak torque and maximum power of the flexor and extensor muscle groups of the knee and hip, before and after two weeks of training with isokinetic exercises. There was a reduction in the coefficient of variation of all four repetitions of flexion and extension of hip and knee on both lower extremities, identifying a greater uniformity in torque curves on revaluation compared to the initial evaluation. CONCLUSIONS: Athletes with lower limb amputation should have an adjustment period with the isokinetic dynamometer in order to familiarize with the execution of concentric and eccentric movements. The absence or inefficiency of this adaptation can compromise data collection for the composition of protocols of treatment and / or training in amputee athletes.Objetivos: Avaliar os efeitos de um treinamento isocinetico no pico de torque e na potencia maxima dos musculos flexores e extensores dejoelho e quadril em um atleta amputado de membro inferior.Descricao do Caso: Avaliou-se um atleta de Triathlon com 27 anos de idade com amputacao congenita do terco proximal da tibia a direita,usuario de protese de alta performance para corrida. Realizou-se perimetria de ambos os membros inferiores, mensuracao do pico de torquee mensuracao da potencia maxima da musculatura flexora e extensora de joelho e quadril, por meio de um dinamometro isocinetico antes eapos duas semanas de treinamento com exercicios no isocinetico. Comparando-se os dados da avaliacao com os da reavaliacao, atraves deanalise descritiva exploratoria, observou-se que houve reducao do coeficiente de variacao das quatro repeticoes dos movimentos de flexaoe extensao de quadril e joelho de ambas as extremidades inferiores, identificando maior uniformidade nas curvas de torque na reavaliacaoquando comparada a avaliacao inicial.Conclusoes: E fundamental um periodo de adaptacao no dinamometro isocinetico em atletas com amputacao de membro inferior, parafamiliarizacao na execucao dos movimentos concentricos e excentricos. A ausencia ou ineficiencia dessa adaptacao podera comprometer osdados para a composicao de protocolos de tratamento e/ou treinamento do atleta com amputacao. Aims: To evaluate the effects of isokinetic training on peak torque and maximum power of the flexor and extensor muscles of the knee andhip articulations in an athlete with lower limb amputationCase Description: We assessed a 27-year-old triathlete amputee, with congenital amputation of proximal third of right tibia and user ofhigh-performance prosthetics for running. The circumference of both lower limbs were measured, and an isokinetic dynamometer wasused to estimate the peak torque and maximum power of the flexor and extensor muscle groups of the knee and hip, before and aftertwo weeks of training with isokinetic exercises. There was a reduction in the coefficient of variation of all four repetitions of flexion andextension of hip and knee on both lower extremities, identifying a greater uniformity in torque curves on revaluation compared to the initialevaluation.Conclusions: Athletes with lower limb amputation should have an adjustment period with the isokinetic dynamometer in order to familiarizewith the execution of concentric and eccentric movements. The absence or inefficiency of this adaptation can compromise data collection forthe composition of protocols of treatment and / or training in amputee athletes.